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Value by Design
Developing Clinical Microsystems to Achieve Organizational Excellence
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Main description:

Value by Design is a practical guide for real–world improvement in clinical microsystems. Clinical microsystem theory, as implemented by the Institute for Healthcare Improvement and health care organizations nationally and internationally, is the foundation of high–performing front line health care teams who achieve exceptional quality and value. These editors combine theory and principles to create a strategic framework and field–tested tools to assess and improve systems of care. Their approach links patients, families, health care professionals and strategic organizational goals at all levels of the organization:?micro, meso and macrosystem levels to achieve the ultimate quality and value a health care system is capable of offering.


Based on research and classes conducted at the Center for Health Care Improvement Leadership at The Dartmouth Institute for Health Policy and Clinical Practice, Value by Design:



  • Covers the foundations of quality, safety, cost improvement, assessment of system performance, and measurement of quality and value


  • Shows how to apply the proven clinical microsystems approach


  • Explains how to apply microsystem concepts and methods in a variety of care settings


  • Offers specific statistical tools for quality and process improvement, such as star diagrams and lean methods.



In addition, the book includes a summary of take–home points and study questions for discussion in small groups as well as illustrative examples of completed working assignments.


Companion Web site: www.josseybass.com/go/nelson


Back cover:

Value by Design is a practical guide for real–world improvement in clinical microsystems. Clinical microsystem theory, as implemented by the Institute for Healthcare Improvement and health care organizations nationally and internationally, is the foundation of high–performing front line health care teams who achieve exceptional quality and value. These editors combine theory and principles to create a strategic framework and field–tested tools to assess and improve systems of care. Their approach links patients, families, health care professionals and strategic organizational goals at all levels of the organization:?micro, meso and macrosystem levels to achieve the ultimate quality and value a health care system is capable of offering.


Based on research and classes conducted at the Center for Health Care Improvement Leadership at The Dartmouth Institute for Health Policy and Clinical Practice, Value by Design:



  • Covers the foundations of quality, safety, cost improvement, assessment of system performance, and measurement of quality and value


  • Shows how to apply the proven clinical microsystems approach


  • Explains how to apply microsystem concepts and methods in a variety of care settings


  • Offers specific statistical tools for quality and process improvement, such as star diagrams and lean methods.



In addition, the book includes a summary of take–home points and study questions for discussion in small groups as well as illustrative examples of completed working assignments.


Companion Web site: www.josseybass.com/go/nelson


Contents:

Figures and Tables xi


Foreword Elliott S. Fisher xvii


Preface: Improvement at the Front Line of Care xxi


Acknowledgments xxix


The Editors xxxiii


The Contributors xxxv


1 Introducing Clinical Microsystems 1


Learning Objectives 1


Microsystems in Health Care 1


A Broader View of Systems and Microsystems 6


Research on Microsystems in Health Care 11


Three Conceptual Imperatives in the Work of Value Improvement 20


Conclusion 24


Summary 25


Key Terms 25


Review Questions 26


Discussion Questions 26


References 26


Chapter One Action Guide 29


Introduction to the 5PS 29


The Clinical Microsystem Process and Structure of the 5Ps Model 29


External Mapping Tool 35


Microsystem Assessment Tool (MAT) 40


2 Partnering with Patients to Design and Improve Care 47


Learning Objectives 47


The Aim of Health Care and the Need to Partner with Patients 48


Conceptual Frameworks for Partnering with Patients 51


Tactics for Partnering with Patients 61


Patients as Informants and Advisors 65


Conclusion 67


Summary 67


Key Terms 67


Review Questions 68


Discussion Questions 68


References 68


Chapter Two Action Guide 71


Gaining Customer Knowledge 71


Institute for Patient and Family–Centered Care Matrix 82


Value Stream Mapping 83


Definitions of Selected Value Stream Mapping Terms 84


3 Improving Safety and Anticipating Hazards in Clinical Microsystems 87


Learning Objectives 87


Case Study of Organizational Factors to Promote a Culture of Safety 88


Discussion 92


Definitions 93


Identification of Medical Errors and Adverse Events 94


Frequency of Adverse Events and Medical Errors 95


Conclusion 107


Summary 107


Key Terms 108


Review Questions 108


Discussion Questions 109


References 109


Chapter Three Action Guide 113


5S Method 113


Checklists 116


Failure Mode and Effects Analysis 118


Rehearsals or Simulations 120


Designing Patient Safety into the Microsystem 122


The Link Between Safety, the Microsystem, and Mindfulness 123


Conclusion 129


References 130


4 Using Measurement to Improve Health Care Value 131


Learning Objectives 131


Measuring What Matters at All Levels of the System 132


Tips and Principles to Foster a Rich Information Environment 138


Designing Information Flow to Support High–Value Care 140


Conclusion 150


Summary 151


Key Terms 152


Review Questions 152


Discussion Questions 152


References 153


Chapter Four Action Guide 155


Patient Value Compass 155


Balanced Scorecard 156


Measure What Matters Worksheet 157


Examples of Data Walls 159


References 160


5 Starting the Patient s Care in Clinical Microsystems 161


Learning Objectives 161


The Entry Functions of Clinical Microsystems 162


Conclusion 182


Summary 183


Key Terms 183


Review Questions 183


Discussion Questions 184


References 184


Chapter Five Action Guide 187


Process Mapping with Flowcharts 187


Access Measures and Tools 190


CARE Vital Signs 192


Reference 195


6 Designing Preventive Care to Improve Health 197


Learning Objectives 197


The Work of Preventive Health Care 198


An Action–Based Taxonomy of Preventive Health Services 202


Conclusion 213


Summary 213


Key Terms 213


Review Questions 214


Discussion Questions 214


References 214


Chapter Six Action Guide 217


Radiology Microsystem Preventive Activity of Mammography and VAP Bundles in Critical Care 217


7 Planning for Responsive and Reliable Acute Care 221


Learning Objectives 221


Anticipating the Needs of Acutely Ill Patients 222


Defining Acute Care Needs of Patients and Families 222


An Overview of Design Requirements for Acute Care 225


Advanced Access and Effective Care Transitions 233


Conclusion 235


Summary 236


Key Terms 236


Review Questions 236


Discussion Questions 237


References 237


Chapter Seven Action Guide 239


Microsystem Transitions and Handoffs 240


8 Engaging Complexity in Chronic Illness Care 241


Learning Objectives 241


An Invitation to Complexity 242


The Experience of Chronic Illness 244


The Burden of Chronic Illness 245


The Goals of Chronic Illness Care 248


Clinical Complexity in Chronic Illness Care 250


Designing for Complexity Through Alignment of Problems and Practice Solutions 252


The Nature of Complex Adaptive Systems 254


The Chronic Care Model 255


Care Coordinaton and Transitions 260


Patient Self–Management 262


Conclusion 265


Summary 266


Key Terms 266


Review Questions 267


Discussion Questions 267


References 267


Chapter Eight Action Guide 271


STAR Generative Relationships 271


Reference 273


9 Supporting Patients and Families Through Palliative Care 277


Learning Objectives 277


The Need for Palliative Care in Modern America 278


End–of–Life Experience Yesterday and Today 279


Principles of Palliative Care 281


Reducing Variation in End–of–Life Care 283


Core Processes in Palliative Care 285


Care Coordination Near the End of Life 287


Formal Palliative Care and Hospice Programs 289


Planning for Both Life and Death with Advance Directives 291


Conclusion 293


Summary 295


Key Terms 295


Review Questions 295


Discussion Questions 296


References 296


Chapter Nine Action Guide 297


Mental Models 297


Using the Ladder of Inference to Explore Mental Models 297


Reference 301


10 Designing Health Systems to Improve Value 303


Learning Objectives 303


From Parts to Whole 304


New Vision of Integrated Systems to Produce High Value 305


The Execution Triangle 313


Leading Change at All Levels 315


Changing Local Culture 318


The Path Forward for Making High–Value Health Systems 323


Summary 326


Key Terms 326


Review Questions 326


Discussion Questions 327


References 327


Chapter Ten Action Guide 331


Micro–, Meso–, and Macrosystem Matrix 331


Index 335


PRODUCT DETAILS

ISBN-13: 9780470901335
Publisher: John Wiley & Sons
Publication date: April, 2011
Pages: 384
Dimensions: 203.00 x 252.00 x 15.52

Subcategories: General Practice, Public Health

MEET THE AUTHOR

Eugene C. Nelson, DSc, MPH, is director of Population Health and Measurement for the Dartmouth–Hitchcock Medical Center and professor of Community and Family Medicine at Dartmouth Medical School and the Dartmouth Institute for Health Policy and Clinical Practice. He is the recipient of the Joint Commission on Accreditation of Healthcare Organizations′ Ernest A. Codman award for his work on outcomes measurement in health care.


Paul B. Batalden, MD, is professor of Pediatrics and of Community and Family Medicine at Dartmouth Medical School. He is the associate director of the Dartmouth–Hitchcock Leadership Preventive Medicine Residency, and teaches at the Dartmouth Institute for Health Policy and Clinical Practice, the Institute for Healthcare Improvement and in the Jönköping Academy for the Improvement of Health and Welfare in Sweden.


Marjorie M. Godfrey, MS, RN, is codirector of the Microsystem Academy, instructor for the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, and a recognized national and international leader in health care improvement with interdisciplinary professionals.


Joel S. Lazar, MD, MPH, is assistant professor of Community and Family Medicine at the Dartmouth Institute for Health Policy and Clinical Practice and section chief and medical director of Family Medicine at Dartmouth–Hitchcock Medical Center, where he also serves as director of quality improvement.